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Seeing a Neurologist May Boost Parkinsonís Survival and Quality of Life

- Aug 10 2011

People with Parkinson’s disease (PD) who were cared for by a neurologist lived longer and were less likely to break a hip or be placed in a skilled nursing facility than those who saw primary care physicians, according to research reported in the August 10, 2011 online issue of Neurology. The study also found that women and minorities with PD were less likely to see a neurologist than white men.

The study authors, led by Allison W. Willis, M.D., at the Washington University School of Medicine, in St. Louis, first wanted to find out how often people with PD seek treatment from a neurologist. To do so, they examined the medical records of every individual on Medicare (the U.S. government health insurance system for people over 65 years old) who was newly diagnosed with PD and seen in an outpatient clinic in 2002 — more than 138,000 people.

Then the researchers analyzed differences between those who were treated by a neurologist between 2002 and 2005 and those who were not. The information gathered for the people with PD included race, gender, socioeconomic variables, whether a person went to live in a nursing home as well as whether a person had a hip fracture or died within six years of being diagnosed with Parkinson’s. About half of the people with PD were men, and more than 90 percent were white.

Results

Only 50 percent of people who developed Parkinson’s during the study period were treated by a neurologist. 58 percent of all people living with Parkinson’s, regardless of diagnosis year, saw a neurologist.

Newly diagnosed individuals treated by neurologists, when compared to those whose physicians were either internists, family practitioners or geriatricians, were:

20 percent less likely to die after six years;

20 percent less likely to be placed in a skilled nursing facility; and

14 percent less likely to have broken a hip after one year.

Newly diagnosed white and black males fared the worst under the treatment of non-neurologists but when both groups were under the care of neurologist, the survival of white males improved more than that of black males.

The survival of Asian females was largely unaffected by the care of a neurologist.

Overall, minorities were 17 percent less likely to see a neurologist than whites.

Among those developing PD during the study period:

women and blacks were 22 percent less likely to be referred to a neurologist for their PD;

individuals in their early 80’s were 19 percent less likely to see a neurologist while those 85 and older were 54 percent less likely.

What Does it Mean?

This study shows that many people diagnosed with PD are not treated by a neurologist, and that women and minorities are less likely to see a neurologist than white men. It also suggests specific benefits to seeking care from a neurologist, such as avoiding falls—and consequently breaking a hip—and deferring or avoiding being placed in a skilled nursing facility, which is a transition in care that can be distressing to people with PD and their loved ones. The research also suggests that people newly diagnosed with PD who see a neurologist may live longer than those treated by non-neurologists.

The study had two important findings: first, that a large minority of people with PD were not treated by neurologists. This finding is overwhelming considering that the study population was by definition an insured population (Medicare), which does not require a referral to a neurologist. Moreover, there is evidence that diagnosis and treatment by a neurologist which is movement disorders specialist is superior to treatment and diagnosis made by neurologists without this specific training. The second finding of the study, that outcomes are superior when people with PD are treated by neurologists should be interpreted - as the authors themselves note - cautiously, since many potentially confounding factors were not considered. If confirmed, these results support improving access to care by neurologists for all people with PD.